273 results on '"Maria A. CERRUTO"'
Search Results
2. Prostate cancer volume associates with preoperative plasma levels of testosterone that independently predicts high grade tumours which show low densities (quotient testosterone/tumour volume)
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Antonio B. Porcaro, Aldo Petrozziello, Matteo Brunelli, Filippo Migliorini, Giovanni Cacciamani, Davide De Marchi, Nicolo' de Luyk, Irene Tamanini, Beatrice Caruso, Maria A. Cerruto, Claudio Ghimenton, and Walter Artibani
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Total testosterone ,Tumour volume ,Prostate-specific antigen ,Prostate cancer ,Pathology Gleason score ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Objective: To investigate potential associations of preoperative total testosterone (TT) with tumor volume (TV) and grade of prostate cancer (PCa). Methods: Patients who were under medications impacting on the hypothalamic-pituitary-adrenal-testis-prostate axis were excluded. TT was measured preoperatively at least 1 month after biopsies and TV was calculated on the removed prostate specimen. Other continuous variables included total prostate specific antigen (PSA), percentage of positive cores (P+) and weight (W) of the removed prostate. Patients were categorized according to the pathologic Gleason score (pGS) in 3 groups (pGS 6, 7 and > 7). Invasion of the seminal vesicles was coded as seminal vesicle invasion (SVI). Results: The median levels of TT were significantly and increasingly higher from pGS 6 (14.7 nmol/L) to pGS 7 (15.0 nmol/L) and pGS > 7 (18.8 nmol/L). The median values of TV were also detected significantly and increasingly higher from pGS 6 (5.6 mL) to pGS 7 (8.1 mL) and pGS > 7 (14.8 mL). The median preoperative levels of PSA were also increasing from pGS 6 (5.9 μg/L) to pGS 7 (6.2 μg/L) and pGS > 7 (7.7 μg/L). There was a significant and positive correlation of TV to PSA, TT and P+. Multiple linear regression analysis showed that TV was significantly and independently predicted by TT, PSA and P+. High grade PCa (pGS > 7) independently associated with TV, TT, P+ and SVI. The median density values of TT relative to TV (quotient TT/TV) significantly decreased from pGS 6 (2.6 nmol/L/mL) to pGS 7 (1.9 nmol/L/mL) and pGS > 7 (1.4 nmol/L/mL). The median density values of PSA relative to TV (quotient PSA/TV) also significantly decreased from pGS (1.1 μg/L/mL) to pGS 7 (0.7 μg/L/mL) and pGS > 7 (0.6 μg/L/mL). Conclusion: The investigation shows that TT relates to volume and grade of PCa; moreover, the density of TT relative to TV inversely associates with rate of increase of cancer that depends on the grade of the tumour.
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- 2016
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3. Prostate chronic inflammation type IV and prostate cancer risk in patients undergoing first biopsy set: Results of a large cohort study
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Antonio Benito Porcaro, Giovanni Novella, Matteo Balzarro, Guido Martignoni, Matteo Brunelli, Giovanni Cacciamani, Maria A. Cerruto, and Walter Artibani
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Prostate ,Prostate cancer ,Prostate specific antigen ,Prostate biopsy ,Chronic inflammation ,Prostate volume ,Biopsy Gleason score ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Objective: In prostate specimens, chronic inflammatory infiltrate (CII) type IV has been detected, but its association with prostate cancer (PCa) is controversial. The aim of the present study is to investigate on associations of CII with PCa detection in patients undergoing prostate first biopsy set. Methods: Ultrasound transrectal-guided biopsies by the transperineal approach were retrospectively evaluated in 441 consecutive patients. The study excluded patients who were in active surveillance, prostate specific antigen (PSA) ≥30 ng/mL, re-biopsies, incidental PCa after transurethral resection of the prostate (TURP), less than 14 cores or metastatic. Analysis of population and subpopulations (with or without PCa) was performed by statistical methods which included Mann–Whitney (U test), Kruskal–Wallis test, Chi-squared statistic, logistic regression. Multivariate logistic regression models predicting mean probability of PCa detection were established. Results: PCa detection rate was 46.03%. Age, PSA, prostate volume (PV), prostate intraepithelial neoplasia (PIN) and CII were the significant independent predictors of PCa detection. PV (OR = 0.934) and CII (OR = 0.192) were both negative independent predictors. CII was a significant negative independent predictor in multivariate logistic regression models predicting the mean probability of PCa detection by age, PSA and PV. The inverse association of CII with PCa does not necessary mean protection because of PSA confounding. Conclusion: In a population of patients undergoing prostate first biopsy set, CII was a strong negative independent predictor of PCa detection. CII type IV should be considered as an adjunctive parameter in re-biopsy or active surveillance protocols.
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- 2015
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4. Intraoperative Performance of DaVinci Versus Hugo RAS During Radical Prostatectomy: Focus on Timing, Malfunctioning, Complications, and User Satisfaction in 100 Consecutive Cases (the COMPAR-P Trial)
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Alessandro Antonelli, Alessandro Veccia, Sarah Malandra, Riccardo Rizzetto, Vincenzo De Marco, Alberto Baielli, Andrea Franceschini, Francesca Fumanelli, Francesca Montanaro, Iolanda Palumbo, Greta Pettenuzzo, Luca Roggero, Maria Angela Cerruto, Riccardo Bertolo, Michele Aloe, Francesco Artoni, Paolo Bianchi, Claudio Brancelli, Sonia Costantino, Peres Fokana Pongmoni, Piero Fracasso, Giulia Marafioti Patuzzo, Antonio Raiti, Endri Toska, and Vincenzo Vetro
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DaVinci ,Hugo RAS ,Robotic surgery ,Radical prostatectomy ,Surgical outcomes ,Performance ,Diseases of the genitourinary system. Urology ,RC870-923 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background and objective: The Hugo RAS and DaVinci Xi systems are used for performing robot-assisted radical prostatectomy (RARP). This study aims to compare these two platforms providing granular and comprehensive data on their intraoperative performance. Methods: The Comparison of Outcomes of Multiple Platforms for Assisted Robotic surgery—Prostate (COMPAR-P) trial is a prospective post-market study (clinicaltrials.org NCT05766163). Enrollment began in March 2023, allocating patients to DaVinci or Hugo RAS for RARP, without selection criteria, for up to 50 consecutive cases. Two experienced console surgeons performed the procedures, following the same technique. Evaluation focused on timing, learning curves, malfunctioning events, complications, and users’ satisfaction, using standard statistical methods, including the cumulative summation analysis (CUSUM) for the learning curve assessment. Key findings and limitations: Fifty patients each were enrolled for DaVinci (DV-RARP) and Hugo RAS (H-RARP) RARP. Baseline features were balanced. DV-RARP showed significantly shorter “setup” and “console” phase durations than H-RARP (37 vs 55 min and 97 vs 126 min, respectively, p
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- 2024
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5. Assessing the perioperative outcomes of abdominal drain omission after robot-assisted partial nephrectomy
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Francesco Ditonno, Riccardo Bertolo, Alessandro Veccia, Sonia Costantino, Francesca Montanaro, Francesco Artoni, Alberto Baielli, Michele Boldini, Davide Brusa, Vincenzo De Marco, Filippo Migliorini, Antonio Benito Porcaro, Riccardo Rizzetto, Maria Angela Cerruto, Riccardo Autorino, and Alessandro Antonelli
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Renal neoplasm ,Robotic ,Nephrectomy ,Drain ,Complications ,Medicine ,Science - Abstract
Abstract The study aimed to evaluate the impact of abdominal drain placement (vs. omission) on perioperative outcomes of robot-assisted partial nephrectomy (RAPN), focusing on complications, time to canalization, deambulation, and pain management. A prospectively-maintained institutional database was queried to get data of patients who underwent RAPN for renal masses between January 2018 and May 2023 at our Institution. Baseline, surgical, and postoperative data were collected. Retrieved patients were stratified based upon placement of abdominal drain (Y/N). Descriptive analyses comparing the two groups were conducted as appropriate. After adjusting for potential confounders, a logistic regression analysis was conducted to evaluate significant predictors of any grade and “major” complications. 342 patients were included: 192 patients in the “drain group” versus 150 patients in the “no-drain” group. Renal masses were larger (p
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- 2024
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6. 8 - Impact of anesthetic risk on feasibility, complications and outcomes of males treated with Rezum procedure for bladder outlet obstruction
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Luca Roggero, Matteo Balzarro, Michele Boldini, Filippo Antonio Maria Saccà, Claudio Brancelli, Piero Fracasso, Sonia Costantino, Sarah Malandra, Luca Dal Corso, Maria Angela Cerruto, Alessandro Antonelli, and Emanuele Rubilotta
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2024
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7. 8F - How the presence of a proctor specialist in the operating room impacts the experience of the scrub nurse during the implantation of the sacral neuromodulator
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Luca Dal Corso, Veronica Gilioli, Matteo Bogoni, Michele Boldini, Emanuele Rubilotta, Riccardo Bertolo, Alessandro Antonelli, and Maria Angela Cerruto
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2024
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8. Robot-assisted staged bilateral reno-lymphatic disconnection for massive idiopathic chyluria: A case report
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Sonia Costantino, Francesca Montanaro, Alberto Bianchi, Greta Pettenuzzo, Riccardo Bertolo, Maria Angela Cerruto, Alessandro Veccia, and Alessandro Antonelli
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Case report ,Chyluria ,Pediatric ,Milky urine ,Robotic surgery ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Chyluria, an abnormal lymphatic disorder, results in excessive abdominal lymph drainage into the urinary system, causing protein loss, nutritional deficiencies, and immune issues. Mainly linked to parasitic infections in developed countries, non-parasitic causes like trauma or tumors are rare. Typically appearing in adults with bilateral involvement, management options include conservative or surgical approaches. We present the case of a 13-year-old with congenital chyluria, treated with robot-assisted staged reno-lymphatic disconnection after failed interventional radiology. Bilateral scleroangiography followed, leading to persistently milky urine for a month. Finally, urine clarity improved, correlating with better urinalysis, emphasizing the need for a comprehensive, multi-disciplinary approach.
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- 2024
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9. Intravesical Botulin Toxin-A Injections for Neurogenic Bladder Dysfunction in Children: Summary Update on Last 10 Years of Research
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Andrea Zulli, Virginia Carletti, Alberto Mantovani, Maria Angela Cerruto, and Luca Giacomello
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neurogenic bladder ,pediatric urology ,botulin toxin-A ,Medicine - Abstract
Neurogenic bladder dysfunction (NB) represents a challenge in pediatric urology. Intravesical botulin toxin-A (BTX-A) bladder injection is part of the armamentarium for the treatment of this condition, usually after failed first-line medical strategies and before the escalation to more invasive options such as neuromodulation or augmented cystoplasty in severe cases. However, there is still a lack of consensus about the appropriate treatment modality for the pediatric population. A review of the last 10 years’ research was performed on the PubMed database by two authors. Articles doubly selected and meeting the inclusion criteria were collected and analyzed for their study type, demographics, neurological disease(s) at diagnosis, BTX-A treatment modality and duration, previous treatment, clinical and urodynamic parameters, adverse events, outcomes, and follow-ups. A total of 285 studies were initially selected, 16 of which matched the inclusion criteria. A cohort of 630 patients was treated with BTX-A at a median age of 9.7 years, 40% of which had a diagnosis of myelomeningocele. The results of the selected publications show the overall efficacy and safety of BTX-A injections in children and confirmed BTX-A as a valuable strategy for NB treatment in pediatric population. Nevertheless, up to now, the literature on this topic offers scarce uniformity among the published series and poor protocol standardization.
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- 2024
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10. Robot-assisted excision of hemangioma of the right renal vein
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Francesca Montanaro, Riccardo Bertolo, Sonia Costantino, Nicola De Maria, Alessandro Veccia, Filippo Migliorini, Anna Caliò, Matteo Brunelli, Stefania Montemezzi, Maria Angela Cerruto, and Alessandro Antonelli
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Robotic ,Hemangioma ,Renal neoplasm ,Nephron-sparing ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Hemangiomas, benign vascular masses, occasionally occur in the kidneys, presenting as rare, small, unilateral, and solitary growths. Venous hemangiomas, a renal subtype, are atypical. While clinically nonspecific, they are typically asymptomatic and may be incidentally discovered during unrelated clinical workups. Diagnosing renal hemangioma preoperatively is challenging due to rarity, lacking standard radiographic criteria, and poor differentiation from aggressive renal neoplasms on contrast-enhanced imaging. These tumors commonly follow a benign course, with no documented recurrence. This video article showcases the robot-assisted excision of a renal vein hemangioma, addressing the expertise needed in managing this uncommon condition robotically.
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- 2024
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11. The impact of prognostic group classification on prostate cancer progression in intermediate-risk patients according to the European Association of Urology system: results in 479 patients treated with robot-assisted radical prostatectomy at a single tertiary referral center
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Antonio Benito Porcaro, Alberto Bianchi, Andrea Panunzio, Sebastian Gallina, Alessandro Tafuri, Emanuele Serafin, Rossella Orlando, Giovanni Mazzucato, Stefano Vidiri, Damiano D’Aietti, Francesca Montanaro, Giulia Marafioti Patuzzo, Francesco Artoni, Alberto Baielli, Francesco Ditonno, Riccardo Rizzetto, Alessandro Veccia, Alessandra Gozzo, Vincenzo De Marco, Matteo Brunelli, Maria Angela Cerruto, and Alessandro Antonelli
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Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Background: Treatment outcomes in intermediate-risk prostate cancer (PCa) may be impaired by adverse pathology misclassification including tumor upgrading and upstaging. Clinical predictors of disease progression need to be improved in this category of patients. Objectives: To identify PCa prognostic factors to define prognostic groups in intermediate-risk patients treated with robot-assisted radical prostatectomy (RARP). Design: Data from 1143 patients undergoing RARP from January 2013 to October 2020 were collected: 901 subjects had available follow-up, of whom 479 were at intermediate risk. Methods: PCa progression was defined as biochemical recurrence and/or local recurrence and/or distant metastases. Study endpoints were evaluated by statistical methods including Cox’s proportional hazards, Kaplan–Meyer survival curves, and binomial and multinomial logistic regression models. Results: After a median (interquartile range) of 35 months (15–57 months), 84 patients (17.5%) had disease progression, which was independently predicted by the percentage of biopsy-positive cores ⩾ 50% and the International Society of Urological Pathology (ISUP) grade group 3 for clinical factors and by ISUP > 2, positive surgical margins and pelvic lymph node invasion for pathological features. Patients were classified into clinical and pathological groups as favorable, unfavorable (one prognostic factor), and adverse (more than one prognostic factor). The risk of PCa progression increased with worsening prognosis through groups. A significant positive association was found between the two groups; consequently, as clinical prognosis worsened, the risk of detecting unfavorable and adverse pathological prognostic clusters increased in both unadjusted and adjusted models. Conclusion: The study identified factors predicting disease progression that allowed the computation of highly correlated prognostic groups. As the prognosis worsened, the risk of PCa progression increased. Intermediate-risk PCa needs more prognostic stratification for appropriate management.
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- 2024
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12. A Systematic Review of Botulinum Toxin Injection in Pediatric Dystonia
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Andrea Rasera, Giovanna Maddalena Squintani, and Maria Angela Cerruto
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botulinum toxin ,pediatric dystonia ,dystonia treatment ,Medicine - Abstract
Botulinum toxin (BT), a first-line treatment for focal dystonias in adults, has gained USA Food and Drug Administration approval for pediatric upper and lower extremity spasticity and sialorrhea, though its use in children younger than 2 years old is still considered off-label treatment for all pathologies. Dosing, treatment strategies and outcome measures lack international consensus, and they are often extrapolated from adult or spasticity guidelines. This review aims to evaluate the best available evidence on the efficacy and safety of BT therapy in pediatric dystonia (age under 21 years old), isolated or associated with other medical conditions. A comprehensive search in PubMed, Scopus and Web of Science was conducted, including only articles in English. Although no randomized controlled trials are still present, 12 articles were included with an overall of 57 patients. All the papers demonstrate that BT can improve motor function, decrease pain and ameliorate quality of life, with minimal adverse effects in pediatric patients affected by pure or mixed dystonic motor disorders. Despite the low level of evidence, our review shows that BT could be an efficacious treatment for these pediatric patients. The frequent generalized involvement, together with the heterogeneous nature of childhood dystonic forms, sometimes intermingled with spasticity, prompts further multicenter clinical trials or prospective studies with a higher level of evidence to shed light on the efficacy and safety profile of BT in pediatric dystonia.
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- 2024
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13. Endogenous testosterone density associates with predictors of tumor upgrading and disease progression in the low through favorable intermediate prostate cancer risk categories: analysis of risk factors and clinical implications
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Antonio B. Porcaro, Alberto Bianchi, Sebastian Gallina, Francesco Ditonno, Paola I. Ornaghi, Emanuele Serafin, Alessandro Tafuri, Andrea Panunzio, Clara Cerrato, Stefano Vidiri, Damiano D’Aietti, Giovanni Mazzucato, Riccardo Rizzetto, Nelia Amigoni, Vincenzo De Marco, Filippo Migliorini, Stefano Zecchini Antoniolli, Matteo Brunelli, Salvatore Siracusano, Maria Angela Cerruto, and Alessandro Antonelli
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Prostate cancer ,Open or robotic radical prostatectomy ,Endogenous testosterone density ,Prostate-specific antigen density ,Percentage of biopsy positive cores density ,Tumor load density ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Abstract Background The study aimed to test the hypothesis that endogenous testosterone density (ETD), in the low through favorable intermediate PCa risk classes patients undergoing surgery, might be associated with disease progression. Materials and methods ETD, PSAD, and percentage of biopsy positive cores density (BPCD) were calculated in relation to prostate volume (PV). Tumor load density (TLD) was estimated as the tumor load (TL) ratio to prostate weight. ET was considered low if 2), upstaging (pT > 2) and their related features were investigated. Results 433 patients were included, 249 (57.5%) from the favorable intermediate-risk class. Upgrading occurred in 168 (38.8%) cases and upstaging in 62 (14.3%). ETD above the median (9.9 ng/(dL x mL)), was discriminated by PSAD (AUC = 0.719; 95% CI: 0.671–0.766; p
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- 2023
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14. Ileal Conduit Versus Orthotopic Neobladder Urinary Diversion in Robot-assisted Radical Cystectomy: Results from a Multi-institutional Series
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Stefano Tappero, Paolo Dell'Oglio, Maria Angela Cerruto, Rafael Sanchez Salas, Oscar Buisan Rueda, Giuseppe Simone, Kees Hendricksen, Francesco Soria, Paolo Umari, Alessandro Antonelli, Alberto Briganti, Francesco Montorsi, Ottavio de Cobelli, Carlo Terrone, Antonio Galfano, Marco Moschini, and Ettore Di Trapani
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Ileal conduit ,Orthotopic neobladder ,Radical cystectomy ,Robotic surgery ,Urothelial bladder cancer ,Diseases of the genitourinary system. Urology ,RC870-923 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Head-to-head comparisons between ileal conduit (IC) and orthotopic neobladder (ONB) in terms of peri- and postoperative outcomes and complications, in the specific setting of robot-assisted radical cystectomy (RARC), are not available. Objective: To address the impact of the type of urinary diversion (UD, IC vs ONB) on RARC morbidity, as well as operative time (OT), length of stay (LOS), and readmissions. Design, setting, and participants: Urothelial bladder cancer patients treated with RARC at nine high-volume European institutions between 2008 and 2020 were identified. Intervention: RARC with either IC or ONB. Outcome measurements and statistical analysis: Intra- and postoperative complications were collected and reported according to the Intraoperative Complications Assessment and Reporting with Universal Standards recommendations and European Association of Urology guidelines, respectively. Multivariable logistic regression models tested the impact of UD on outcomes, after adjustment for clustering at single hospital level. Results and limitations: Overall, 555 nonmetastatic RARC patients were identified. In 280 (51%) and 275 (49%) patients, an IC and an ONB were performed, respectively. Eighteen intraoperative complications were recorded. The rates of intraoperative complications were 4% in IC patients and 3% in ONB patients (p = 0.4). The median LOS and readmission rates were 10 versus 12 d (p
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- 2023
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15. Clinical implications of endogenous testosterone density on prostate cancer progression in patients with very favorable low and intermediate risk treated with radical prostatectomy
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Antonio Benito Porcaro, Alessandro Tafuri, Andrea Panunzio, Clara Cerrato, Alberto Bianchi, Sebastian Gallina, Stefano Vidiri, Damiano D'Aietti, Emanuele Serafin, Giovanni Mazzucato, Alessandro Princiotta, Davide Brusa, Matteo Brunelli, Vincenzo Pagliarulo, Maria Angela Cerruto, and Alessandro Antonelli
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endogenous testosterone density ,prostate cancer ,radical prostatectomy ,tumor progression ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
We tested the association between endogenous testosterone density (ETD; the ratio between endogenous testosterone [ET] and prostate volume) and prostate cancer (PCa) aggressiveness in very favorable low- and intermediate-risk PCa patients who underwent radical prostatectomy (RP). Only patients with prostate-specific antigen (PSA) within 10 ng ml−1, clinical stage T1c, and International Society of Urological Pathology (ISUP) grade group 1 or 2 were included. Preoperative ET levels up to 350 ng dl−1 were classified as abnormal. Tumor quantitation density factors were evaluated as the ratio between percentage of biopsy-positive cores and prostate volume (biopsy-positive cores density, BPCD) and the ratio between percentage of cancer invasion at final pathology and prostate weight (tumor load density, TLD). Disease upgrading was coded as ISUP grade group >2, and progression as recurrence (biochemical and/or local and/or distant). Risk associations were evaluated by multivariable Cox and logistic regression models. Of 320 patients, 151 (47.2%) had intermediate-risk PCa. ET (median: 402.3 ng dl−1) resulted abnormal in 111 (34.7%) cases (median ETD: 9.8 ng dl−1 ml−1). Upgrading and progression occurred in 109 (34.1%) and 32 (10.6%) cases, respectively. Progression was predicted by ISUP grade group 2 (hazard ratio [HR]: 2.290; P = 0.029) and upgrading (HR: 3.098; P = 0.003), which was associated with ISUP grade group 2 (odds ratio [OR]: 1.785; P = 0.017) and TLD above the median (OR: 2.261; P = 0.001). After adjustment for PSA density and body mass index (BMI), ETD above the median was positively associated with BPCD (OR: 3.404; P < 0.001) and TLD (OR: 5.238; P < 0.001). Notably, subjects with abnormal ET were more likely to have higher BPCD (OR: 5.566; P = 0.002), as well as TLD (OR: 14.998; P = 0.016). Independently by routinely evaluated factors, as ETD increased, BPCD and TLD increased, but increments were higher for abnormal ET levels. In very favorable cohorts, ETD may further stratify the risk of aggressive PCa.
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- 2023
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16. Association between ABO blood group and unfavorable prostate cancer features after radical prostatectomy: Retrospective study of 1149 patients
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Antonio Benito Porcaro, Nelia Amigoni, Riccardo Rizzetto, Filippo Migliorini, Alessandro Tafuri, Pierluigi Piccoli, Leone Tiso, Mario De Michele, Alberto Bianchi, Sebastian Gallina, Paola Irene Ornaghi, Rossella Orlando, Francesco Cianflone, Alessandra Gozzo, Stefano Zecchini Antoniolli, Vincenzo Lacola, Matteo Brunelli, Maria Angela Cerruto, Walter Artibani, and Alessandro Antonelli
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Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Abstract. Objectives. To test hypothesized associations between the ABO blood group (ABO-bg) system and the pathological features of prostate cancer (PCa). Material and methods. Between January 2013 and September 2019, 1173 patients underwent radical prostatectomy. Associations between ABO-bg levels and pathological features were evaluated using statistical methods. Results. Overall, 1149 consecutive patients were evaluated using the ABO-bg system, which was represented by O-bg (42.8%) and A-bg (41.3%), followed by B-bg (11.1%) and AB-bg (4.8%). Only positive surgical margins (PSMs) was correlated with ABO-bg (Pearson correlation coefficient, r = 0.071; p = 0.017), and the risk was increased in group-O (odds ratio [OR], 1.497; 95% confidence interval, 1.149–1.950; p = 0.003) versus non–O-bg. In clinical and pathological models, O-bg was at increased risk of PSM after the adjustment for prostate-specific antigen, percentage of biopsy-positive cores, and high surgical volume (adjusted OR, 1.546; 95% confidence interval, 1.180–2.026; p = 0.002); however, the adjusted OR did not change after the adjustment for tumor load and stage as well as high surgical volume. Conclusions. In clinical PCa, the risk of PSM was higher in O-bg versus non–O-bg patients after the adjustment for standard predictors. Confirmatory studies are needed to confirm the association between ABO-bg and unfavorable PCa features.
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- 2022
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17. 90 - Preliminary results on Onabotulinum Toxin A injections associated to surgery for pelvic organ prolapse and urinary incontinence
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Matteo Balzarro, Francesca Montanaro, Sonia Costantino, Francesco Ditonno, Alessandro Princiotta, Maria Angela Cerruto, Alessandro Antonelli, and Emanuele Rubilotta
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2023
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18. 53 - AMS 800 artificial urinary sphincter with lateral tubing positioning: Data of a high volume center
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Matteo Balzarro, Emanuele Rubilotta, Michele Boldini, Francesca Montanaro, Francesco Ditonno, Maria Angela Cerruto, Alessandro Antonelli, Luca Roggero, and Alessandro Princiotta
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2023
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19. Normal preoperative endogenous testosterone levels predict prostate cancer progression in elderly patients after radical prostatectomy
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Antonio Benito Porcaro, Andrea Panunzio, Alberto Bianchi, Clara Cerrato, Sebastian Gallina, Emanuele Serafin, Giovanni Mazzucato, Stefano Vidiri, Damiano D’Aietti, Rossella Orlando, Davide Brusa, Matteo Brunelli, Salvatore Siracusano, Vincenzo Pagliarulo, Maria Angela Cerruto, Alessandro Tafuri, and Alessandro Antonelli
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Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Background: The impact of senior age on prostate cancer (PCa) oncological outcomes following radical prostatectomy (RP) is controversial, and further clinical factors could help stratifying risk categories in these patients. Objective: We tested the association between endogenous testosterone (ET) and risk of PCa progression in elderly patients treated with RP. Design: Data from PCa patients treated with RP at a single tertiary referral center, between November 2014 and December 2019 with available follow-up, were retrospectively evaluated. Methods: Preoperative ET (classified as normal if >350 ng/dl) was measured for each patient. Patients were divided according to a cut-off age of 70 years. Unfavorable pathology consisted of International Society of Urologic Pathology (ISUP) grade group >2, seminal vesicle, and pelvic lymph node invasion. Cox regression models tested the association between clinical/pathological tumor features and risk of PCa progression in each age subgroup. Results: Of 651 included patients, 190 (29.2%) were elderly. Abnormal ET levels were detected in 195 (30.0%) cases. Compared with their younger counterparts, elderly patients were more likely to have pathological ISUP grade group >2 (49.0% versus 63.2%). Disease progression occurred in 108 (16.6%) cases with no statistically significant difference between age subgroups. Among the elderly, clinically progressing patients were more likely to have normal ET levels (77.4% versus 67.9%) and unfavorable tumor grades (90.3% versus 57.9%) than patients who did not progress. In multivariable Cox regression models, normal ET [hazard ratio (HR) = 3.29; 95% confidence interval (CI) = 1.27–8.55; p = 0.014] and pathological ISUP grade group >2 (HR = 5.62; 95% CI = 1.60–19.79; p = 0.007) were independent predictors of PCa progression. On clinical multivariable models, elderly patients were more likely to progress for normal ET levels (HR = 3.42; 95% CI = 1.34–8.70; p = 0.010), independently by belonging to high-risk category. Elderly patients with normal ET progressed more rapidly than those with abnormal ET. Conclusion: In elderly patients, normal preoperative ET independently predicted PCa progression. Elderly patients with normal ET progressed more rapidly than controls, suggesting that longer exposure time to high-grade tumors could adversely impact sequential cancer mutations, where normal ET is not anymore protective on disease progression.
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- 2023
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20. AB0 blood groups and oncological and functional outcomes in bladder cancer patients treated with radical cystectomy
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Alessandro Tafuri, Andrea Panunzio, Antonio Soldano, Giovanni Mazzucato, Paola Irene Ornaghi, Giacomo Di Filippo, Alessandra Gozzo, Nicola De Maria, Francesco Cianflone, Aliasger Shakir, Zhe Tian, Matteo Brunelli, Antonio Benito Porcaro, Vincenzo Pagliarulo, Walter Artibani, Pierre I. Karakiewicz, Alessandro Antonelli, and Maria Angela Cerruto
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ABO ,Blood groups ,Bladder Cancer ,Radical Cystectomy ,Outcomes ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Objectives: We investigated AB0 blood groups prevalence according to preoperative and pathological tumor characteristics, and their association with oncological outcomes, and renal function decline in a contemporary large cohort of bladder cancer (BCa) patients, who underwent radical cystectomy (RC) at a tertiary referral center. Materials and Methods: We retrospectively evaluated data of patients with histologically confirmed and clinically non metastatic BCa, who underwent RC between 2014 and 2021 at our Institution. Kaplan-Meier (KM) plots and Cox regression (CR) models tested the relationship between AB0 blood groups and local recurrence-, metastasis-, cancer specific mortality-, and overall mortality-free survival. Logistic regression (LR) models tested the association between AB0 blood groups and renal function decline, defined as an estimated Glomerular Filtration Rate (eGFR) < 60 mL/min, at post-operative day 1, discharge and 6- months of follow-up. Results: Of 301 included patients, 128 (42.5%) had group A, 126 (41.9%) had group 0, 28 (9.3%) had group B, and 19 (6.3%) had group AB. Patients with group 0 developed higher rates of muscle- invasive BCa (p = 0.028) with high-grade features (p = 0.005) at last bladder resection, and less frequently received preoperative immunotherapy with Bacillus of Calmette-Guerin (p = 0.044), than their non-0 counterparts. Additionally, these patients harbored more advanced pathologic tumor stage at RC (p = 0.024). KM plots showed no differences among all tested cancer control outcomes between AB0 blood groups (p > 0.05 in all cases). Patients with group AB presented the lowest median eGFR at each time point. In multivariable LR analyses addressing renal function decline, group AB was independently associated with eGFR< 60 mL/min at discharge (Odds Ratio: 4.28, p = 0.047). Conclusions: Among AB0 blood groups, patients with group 0 exhibited the most aggressive tumor profile. However, no differences were recorded in recurrence or survival rates. Group AB independently predicted renal function decline at discharge.
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- 2022
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21. Prostatic Inflammation in Prostate Cancer: Protective Effect or Risk Factor?
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Alessandro Tafuri, Francesco Ditonno, Andrea Panunzio, Alessandra Gozzo, Antonio Benito Porcaro, Vittore Verratti, Maria Angela Cerruto, and Alessandro Antonelli
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prostatic neoplasm ,prostate biopsy ,prostatic inflammation ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
The relationship between prostatic chronic inflammation (PCI) and prostate cancer (PCa) is unclear and controversial. Some authors reported that a history of chronic prostatitis may be correlated with PCa induction, while others associate chronic inflammation with less aggressive disease or consider inflammation as a possible protective factor against PCa. Four different types of prostatitis are known: bacterial acute prostatic inflammation, bacterial chronic prostatic inflammation, abacterial prostatitis/chronic pelvic pain syndrome, and asymptomatic prostatic chronic inflammation. Prostatic inflammation is underestimated during daily clinical practice, and its presence and degree often go unmentioned in the pathology report of prostate biopsies. The goal of this report is to further our understanding of how PCI influences the biology of PCa. We investigated the main pathogenetic mechanisms responsible for prostatic inflammation, including the cellular response and inflammatory mediators to describe how inflammation modifies the prostatic environment and can lead to benign or malignant prostatic diseases. We found that prostatic inflammation might have a pivotal role in the pathogenesis of prostatic diseases. Details about PCI in all prostate biopsy reports should be mandatory. This will help us better understand the prostatic microenvironment pathways involved in PCa biology, and it will allow the development of specific risk stratification and a patient-tailored therapeutic approach to prostatic diseases.
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- 2021
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22. 52 - Complicated and uncomplicated stress urinary incontinence: Which is the influence of detrusor underactivity on functional and surgical outcomes?
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Emanuele Rubilotta, Matteo Balzarro, Marilena Gubbiotti, Ilaria Gentile, Antonio D’Amico, Maria Angela Cerruto, and Alessandro Antonelli
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2022
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23. 51 - Relationship between symptoms of underactive bladder syndrome and detrusor underactivity in women with lower urinary tract dysfunction
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Emanuele Rubilotta, Matteo Balzarro, Marilena Gubbiotti, Ilaria Gentile, Antonio D’Amico, Maria Angela Cerruto, and Alessandro Antonelli
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2022
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24. 54 - Detrusor hyperactivity with impaired contractility: Prevalence and impact on middle urethral sling outcomes
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Emanuele Rubilotta, Matteo Balzarro, Marilena Gubbiotti, Ilaria Gentile, Antonio D’Amico, Maria Angela Cerruto, and Alessandro Antonelli
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2022
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25. 12 - Comparison of outcomes in women candidates for complicated or uncomplicated stress urinary incontinence surgery
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Emanuele Rubilotta, Matteo Balzarro, Marilena Gubbiotti, Ilaria Gentile, Maria Angela Cerruto, and Alessandro Antonelli
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2022
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26. 53 - Does the female detrusor underactivity cause clinically relevant symptomatic functional impairment?
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Emanuele Rubilotta, Matteo Balzarro, Marilena Gubbiotti, Ilaria Gentile, Antonio D’Amico, Maria Angela Cerruto, and Alessandro Antonelli
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2022
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27. 11 - Botulinum toxin-A injection in chronic pelvic pain syndrome treatment: A systematic review and pooled meta-analysis
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Andrea Panunzio, Alessandro Tafuri, Giovanni Mazzucato, Clara Cerrato, Rossella Orlando, Vincenzo Pagliarulo, Alessandro Antonelli, and Maria Angela Cerruto
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2022
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28. 4 F - Effectiveness of physiotherapy in patients undergoing surgery for endometriosis: Evaluation of sexual and urinary functions
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Monica Pazzaglia, Caterina Paviani, Nicolo’ Trabacchin, Giacomo Beschi, Matteo Balzarro, Antonio D’Amico, Emanuele Rubilotta, Alessandro Antonelli, and Maria Angela Cerruto
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2022
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29. The bladder-flap ureteral augmentation: An original solution in case of complex distal stricture
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Alessandro Antonelli, Nicolò Trabacchin, Carmelo Monaco, Alessandro Tafuri, Maria Angela Cerruto, and Fabrizio Dal Moro
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Bladder-flap ,Ureteral augmentation ,Innovative surgical technique ,Ureteral stricture management ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
An original surgical solution for complex stenosis of the distal ureter is presented. A young, single-kidney male patient developed a stricture of the pelvic ureter after ureteroscopy and laser lithotripsy. Surgical repair was planned after the failure of conservative management. The ureter was sectioned prevesically and spatulated; a bladder flap with the same dimensions of the ureteral plate was taken from the anterior wall, and used to augment the ureter; finally an omental flap was wrapped around the reconstructed tract. Further radiological and ureteroscopic controls showed a largely patent reconstructed ureter, and follow up proved a regularly maintained kidney function.
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- 2021
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30. Preoperative endogenous total testosterone predicts prostate cancer progression: results in 580 consecutive patients treated with robot assisted radical prostatectomy for clinically localized disease
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Antonio Benito Porcaro, Andrea Panunzio, Emanuele Serafin, Alberto Bianchi, Sebastian Gallina, Giovanni Mazzucato, Stefano Vidiri, Damiano D’Aietti, Rossella Orlando, Francesco Ditonno, Francesca Montanaro, Giulia Marafioti Patuzzo, Alberto Bailelli, Francesco Artoni, Stefano Zecchini Antoniolli, Riccardo Rizzetto, Matteo Brunelli, Salvatore Siracusano, Maria Angela Cerruto, Alessandro Tafuri, and Alessandro Antonelli
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Prostatectomy ,Disease progression ,Prostate cancer ,Nephrology ,Urology ,Androgens - Published
- 2023
31. Acute kidney injury strongly influences renal function after radical nephroureterectomy for upper tract urothelial carcinoma: A single-centre experience
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Alessandro Tafuri, Katia Odorizzi, Giacomo Di Filippo, Clara Cerrato, Giulia Fassio, Emanuele Serafin, Alessandro Princiotta, Damiano D'Aietti, Alessandra Gozzo, Antonio B. Porcaro, Matteo Brunelli, Maria Angela Cerruto, and Alessandro Antonelli
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Upper tract urothelial carcinoma ,radical nephroureterectomy ,acute kidney injury ,renal function reduction ,chronic kidney disease ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Objective: The aim of our study was to investigate frequency and predictors both of postoperative acute kidney injury (AKI) and renal function decline in a population of consecutive upper tract urothelial carcinoma (UTUC) patients who underwent radical nephroureterectomy (RNU). Materials and methods: Between October 2014 and February 2020, 93 patients underwent RNU at our Institution. After considered exclusion criteria, 89 patients were selected. Perioperative clinical factors were retrospectively collected. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equation. We defined AKI as an increase in serum creatinine by ≥ 0.3 mg/dl or a 1.5-1.9-fold increase in serum creatinine from baseline to I post-operative day (POD). A significant renal function reduction was defined as an eGFR reduction of 40% from baseline at discharge and at last clinical evaluation. Frequency of AKI and eGFR decline was investigated. Association between perioperative clinical factors and AKI and eGFR reduction at discharged and last follow-up was studied using univariate and multivariate models. Results: AKI was detected at I POD in 45 patients. On multivariate analysis, pre-operative eGFR was an independent predictor of AKI (OR 1.03; p = 0.042). Further, AKI was found to be a significant predictor of eGFR reduction ≥ 40% at discharge at univariate analysis (OR 19.42; p = 0.005) and at multivariate analysis (OR 12.49; p = 0.02). In a multivariate logistic regression model post-operative AKI (OR 5.18; p = 0.033), lack of ipsilateral preoperative hydronephrosis (OR 0.17; p = 0.016), preoperative eGFR (OR 1.04; p = 0.047) and antiplatelet therapy (OR 5.14; p = 0.018) were found to be independent predictors of an eGFR reduction higher than 40% at last clinical evaluation made at a median of 15 (IQR 5-30) months. Conclusions: In our cohort, AKI was present in almost 50% of patients after RNU and it was a strong predictor of renal function decline after RNU.
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- 2021
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32. Impact of functional impairment and cognitive status on perioperative outcomes and costs after radical cystectomy: The role of Barthel Index
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Alessandro Tafuri, Andrea Panunzio, Alessandra Gozzo, Paola Irene Ornaghi, Giacomo Di Filippo, Giovanni Mazzucato, Antonio Soldano, Nicola De Maria, Francesco Cianflone, Walter Artibani, Antonio Benito Porcaro, Vincenzo Pagliarulo, Maria Angela Cerruto, and Alessandro Antonelli
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complications ,Urology ,Barthel Index, complications, frailty, hospitalization, radical cystectomy ,frailty ,Barthel Index ,radical cystectomy ,hospitalization - Abstract
To investigate the association between Barthel Index (BI), which measures level of patients independence during daily living activities (ADL), and perioperative outcomes in a large cohort of consecutive bladder cancer (BCa) patients, who underwent radical cystectomy (RC) at a tertiary referral center.We retrospectively evaluated data from clinically nonmetastatic BCa patients treated with RC between 2015 and 2022. For each patient, BI was assessed preoperatively. According to BI score, patients were divided into three groups: ≤60 (total/severe dependency) vs. 65-90 (moderate dependency) vs. 95-100 (slight dependency/independency). Regression analyses tested the association between BI score and major postoperative complications (Clavien-Dindo2), length of in-hospital stay (LOHS), 90-days readmission, and total costs.Overall, 288 patients were included. According to BI score, the patient cohort was distributed as follows: 4% (n = 11) BI ≤60 vs. 15% (n = 42) BI 65-90 vs. 81% (n = 235) BI 95-100. Patients with BI ≤60 had more frequent ureterocutaneostomy performed, shorter operative time, higher rates of postoperative complications, longer LOHS, higher rates of readmission, and were associated with higher total costs, compared to patients with BI 65-90 and 95-100. In multivariable regression models, BI ≤60 remained an independent predictor of increased risk of major postoperative complications (odds ratio: 6.62, p = 0.006), longer LOHS (rate ratio: 1.25, p 0.001), and higher costs (β: 2.617, p = 0.038).Total/severe dependency in ADL assessed by BI was associated with higher rates of major postoperative complications, longer hospitalization, and higher costs in BCa patients treated with RC. BI assessment should be considered during patients selection process and counseling before surgery.
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- 2022
33. American Society of Anesthesiologists (ASA) physical status system predicts the risk of postoperative Clavien–Dindo complications greater than one at 90 days after robot-assisted radical prostatectomy: final results of a tertiary referral center
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Antonio Benito Porcaro, Riccardo Rizzetto, Alberto Bianchi, Sebastian Gallina, Emanuele Serafin, Andrea Panunzio, Alessandro Tafuri, Clara Cerrato, Filippo Migliorini, Stefano Zecchini Antoniolli, Giovanni Novella, Vincenzo De Marco, Matteo Brunelli, Salvatore Siracusano, Maria Angela Cerruto, Enrico Polati, and Alessandro Antonelli
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Clavien–Dindo complications system ,Postoperative complications ,Prostate cancer ,American Society of Anesthesiologists (ASA) physical status system classification ,Robot-assisted radical prostatectomy ,Health Informatics ,Surgery ,American Society of Anesthesiologists (ASA) physical status system classification, Clavien–Dindo complications system, Postoperative complications, Prostate cancer, Robot-assisted radical prostatectomy - Abstract
To test the hypothesis of an association between the American Society of Anesthesiologists (ASA) physical status classification system and the risk of 90-days postoperative complications after robot-assisted radical prostatectomy (RARP), graded using the Clavien-Dindo classification system (CDS). In a period ranging from January 2013 to October 2020, 1143 patients were evaluated. ASA classification was computed by trained anesthesiologists. Postoperative complications at 90 days after RARP were grouped as greater than one (CDS between 2 and 4a) versus up to one (CDS between 0 and 1). The risk association was computed using logistic regression models. According to ASA physical status classification system, patients were distributed as follows: 102 (8.9%) ASA 1, 934 (81.7%) ASA 2, and 107 (9.4%) ASA 3. Overall, 90-days postoperative complications occurred in 277 (24.2%) cases, of which 137 (12%) were graded as CDS 1 vs. 105 (9.2%) CDS 2 vs. 17 (1.5%) CDS 3a vs. 15 (1.3%) CDS 3b vs. 3 (0.3%) CDS 4a. ASA 2 and 3 patient categories were more likely to have 90-days postoperative complications CDS 1 (12.5% and 16.8%, respectively) compared to ASA 1 patients (4.9%). The risk association was stronger for ASA 3 (odds ratio, [OR]: 4.085; 95%CI: 1.457-11.455; p = 0.007) than for ASA 2 (OR: 2.907; 95%CI: 1.106-7.285; p = 0.023) patient categories. After adjustment for clinical, pathological, and perioperative covariates, including pelvic lymph node dissection (performed vs. not performed), either ASA 2 or 3 categories remained independent predictors of 90-days postoperative complications CDS 1. The risk of 90-days postoperative complications CDS 1 after RARP increased as the ASA physical status deteriorated independently by performing or not an extended pelvic lymph node dissection. In the ASA 3 patients category, RARP should be performed at tertiary referral centers to safely manage the risk of postoperative complications.
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- 2022
34. Changes in renal function after nephroureterectomy for upper urinary tract carcinoma: analysis of a large multicenter cohort (Radical Nephroureterectomy Outcomes (RaNeO) Research Consortium)
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Alessandro Tafuri, Michele Marchioni, Clara Cerrato, Andrea Mari, Riccardo Tellini, Katia Odorizzi, Alessandro Veccia, Daniele Amparore, Aliasger Shakir, Umberto Carbonara, Andrea Panunzio, Federica Trovato, Michele Catellani, Letizia M. I. Janello, Lorenzo Bianchi, Giacomo Novara, Fabrizio Dal Moro, Riccardo Schiavina, Elisa De Lorenzis, Paolo Parma, Sebastiano Cimino, Ottavio De Cobelli, Francesco Maiorino, Pierluigi Bove, Fabio Crocerossa, Francesco Cantiello, David D’Andrea, Federica Di Cosmo, Francesco Porpiglia, Pasquale Ditonno, Emanuele Montanari, Francesco Soria, Paolo Gontero, Giovanni Liguori, Carlo Trombetta, Guglielmo Mantica, Marco Borghesi, Carlo Terrone, Francesco Del Giudice, Alessandro Sciarra, Andrea Galosi, Marco Moschini, Shahrokh F. Shariat, Marta Di Nicola, Andrea Minervini, Matteo Ferro, Maria Angela Cerruto, Luigi Schips, Vincenzo Pagliarulo, Alessandro Antonelli, Tafuri, Alessandro, Marchioni, Michele, Cerrato, Clara, Mari, Andrea, Tellini, Riccardo, Odorizzi, Katia, Veccia, Alessandro, Amparore, Daniele, Shakir, Aliasger, Carbonara, Umberto, Panunzio, Andrea, Trovato, Federica, Catellani, Michele, Janello, Letizia M I, Bianchi, Lorenzo, Novara, Giacomo, Dal Moro, Fabrizio, Schiavina, Riccardo, De Lorenzis, Elisa, Parma, Paolo, Cimino, Sebastiano, De Cobelli, Ottavio, Maiorino, Francesco, Bove, Pierluigi, Crocerossa, Fabio, Cantiello, Francesco, D'Andrea, David, Di Cosmo, Federica, Porpiglia, Francesco, Ditonno, Pasquale, Montanari, Emanuele, Soria, Francesco, Gontero, Paolo, Liguori, Giovanni, Trombetta, Carlo, Mantica, Guglielmo, Borghesi, Marco, Terrone, Carlo, Del Giudice, Francesco, Sciarra, Alessandro, Galosi, Andrea, Moschini, Marco, Shariat, Shahrokh F, Di Nicola, Marta, Minervini, Andrea, Ferro, Matteo, Cerruto, Maria Angela, Schips, Luigi, Pagliarulo, Vincenzo, Antonelli, Alessandro, Tafuri A., Marchioni M., Cerrato C., Mari A., Tellini R., Odorizzi K., Veccia A., Amparore D., Shakir A., Carbonara U., Panunzio A., Trovato F., Catellani M., Janello L.M.I., Bianchi L., Novara G., Dal Moro F., Schiavina R., De Lorenzis E., Parma P., Cimino S., De Cobelli O., Maiorino F., Bove P., Crocerossa F., Cantiello F., D'Andrea D., Di Cosmo F., Porpiglia F., Ditonno P., Montanari E., Soria F., Gontero P., Liguori G., Trombetta C., Mantica G., Borghesi M., Terrone C., Del Giudice F., Sciarra A., Galosi A., Moschini M., Shariat S.F., Di Nicola M., Minervini A., Ferro M., Cerruto M.A., Schips L., Pagliarulo V., and Antonelli A.
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Male ,Urologic Neoplasms ,Acute Kidney Injury ,Chronic Kidney Disease ,Radical Nephroureterectomy ,Upper tract urothelial carcinoma ,Humans ,Infant ,Nephroureterectomy ,Nephrectomy ,Glomerular Filtration Rate ,Retrospective Studies ,Kidney ,Carcinoma, Transitional Cell ,Urinary Bladder Neoplasms ,Urinary Tract ,Ureteral Neoplasms ,Urology ,Retrospective Studie ,Upper tract urothelial carcinoma, Radical Nephroureterectomy, Acute Kidney Injury, Chronic Kidney Disease ,Carcinoma ,Urologic Neoplasm ,Urinary Bladder Neoplasm ,Transitional Cell ,Human - Abstract
Purpose To investigate prevalence and predictors of renal function variation in a multicenter cohort treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods Patients from 17 tertiary centers were included. Renal function variation was evaluated at postoperative day (POD)—1, 6 and 12 months. Timepoints differences were Δ1 = POD-1 eGFR − baseline eGFR; Δ2 = 6 months eGFR − POD-1 eGFR; Δ3 = 12 months eGFR − 6 months eGFR. We defined POD-1 acute kidney injury (AKI) as an increase in serum creatinine by ≥ 0.3 mg/dl or a 1.5 1.9-fold from baseline. Additionally, a cutoff of 60 ml/min in eGFR was considered to define renal function decline at 6 and 12 months. Logistic regression (LR) and linear mixed (LM) models were used to evaluate the association between clinical factors and eGFR decline and their interaction with follow-up. Results A total of 576 were included, of these 409(71.0%) and 403(70.0%) had an eGFR p p = 0.003), POD-1 AKI (OR 2.88, p p p p = 0.007), POD-1 AKI (OR 1.83, p = 0.02), and preoperative eGFR p p = 0.019), hydronephrosis (p p p = 0.001) influenced renal function variation (ß 9.2 ± 0.7, p Conclusion Age, preoperative eGFR and POD-1 AKI are independent predictors of 6 and 12 months renal function decline after RNU for UTUC.
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- 2022
35. Advanced age portends poorer prognosis after radical prostatectomy: a single center experience
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Antonio Benito Porcaro, Alberto Bianchi, Sebastian Gallina, Emanuele Serafin, Giovanni Mazzucato, Stefano Vidiri, Damiano D’Aietti, Riccardo Rizzetto, Alessandro Tafuri, Clara Cerrato, Andrea Panunzio, Rossella Orlando, Davide Brusa, Matteo Brunelli, Salvatore Siracusano, Maria Angela Cerruto, and Alessandro Antonelli
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Male ,Prostatectomy ,Advanced age ,Prostate cancer ,Prostate cancer progression ,Robot-assisted radical prostatectomy ,Aging ,Seminal Vesicles ,Prostatic Neoplasms ,Prognosis ,Disease Progression ,Humans ,Geriatrics and Gerontology ,Aged - Abstract
Introduction and objective Although advanced age doesn’t seem to impair oncological outcomes after robot-assisted radical prostatectomy (RARP), elderly patients have increased rates of prostate cancer (PCa) related deaths due to a higher incidence of high-risk disease. The potential unfavorable impact of advanced age on oncological outcomes following RARP remains an unsettled issue. We aimed to evaluate the oncological outcome of PCa patients > 69 years old in a single tertiary center. Materials and methods 1143 patients with clinically localized PCa underwent RARP from January 2013 to October 2020. Analysis was performed on 901 patients with available follow-up. Patients ≥ 70 years old were considered elderly. Unfavorable pathology included ISUP grade group > 2, seminal vesicle, and pelvic lymph node invasion. Disease progression was defined as biochemical and/or local recurrence and/or distant metastases. Results 243 cases (27%) were classified as elderly patients (median age 72 years). Median (IQR) follow-up was 40.4 (38.7–42.2) months. Disease progression occurred in 159 cases (17.6%). Elderly patients were more likely to belong to EAU high-risk class, have unfavorable pathology, and experience disease progression after surgery (HR = 5.300; 95% CI 1.844–15.237; p = 0.002) compared to the younger patients. Conclusions Elderly patients eligible for RARP are more likely to belong to the EAU high-risk category and to have unfavorable pathology that are independent predictors of disease progression. Advanced age adversely impacts on oncological outcomes when evaluated inside these unfavorable categories. Accordingly, elderly patients belonging to the EAU high-risk should be counseled about the increased risk of disease progression after surgery.
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- 2022
36. Mapping European Association of Urology Guideline Practice Across Europe: An Audit of Androgen Deprivation Therapy Use Before Prostate Cancer Surgery in 6598 Cases in 187 Hospitals Across 31 European Countries
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Steven MacLennan, Nuno Azevedo, Eilidh Duncan, Jennifer Dunsmore, Louise Fullwood, Nicolaas Lumen, Karin Plass, Maria J. Ribal, Monique J. Roobol, Daan Nieboer, Natasha Schouten, Ted A. Skolarus, Emma Jane Smith, James N'Dow, Nicolas Mottet, Alberto Briganti, Isabel Heidegger, Johannes Mischinger Irene Resch, Simon Turba, Robin Zeder, Braninimir Lodeta, Charles Van Praet, Christophe Ghysel, Harm C. Arentsen, Matthias Beysens, Marie-Hélène Vinckier, Alexandre Mottrie, Ruben de Groote, Aleksandar Ivanov Timev, Marincho Ivanov Georgiev, Krassimir Prodanov Yanev, Boris Mladenov, Atanas Slavchev Ivanov, Petar Antonov, Stanislav Valkanov, Igor Tomašković, Tomislav Kulis, Pero Bokarica, Oliver Pavlović, Vinko Krajina, Marijan Situm, Toni Boban, Tomislav Soric, Ivan Vidic, Goran Benko, Zoran Peršec, Tomislav Sović, Roman Zachoval, Jiri Stejskal, Otakar Capoun, Tomáš Pitra, Marek Gojdič, Marek Babjuk, Vojtěch Novák, Michal Grepl, Marek Broul, Jan Novák, Lars Lund, Ulla Nordström Joensen, Michael Borre, Priit Veskimäe, Peep Baum, Toomas Tamm, Rauno Okas, Pyry Jämsä, Kanerva Lahdensuo, Sirkku Siltari, Heikki Seikkula, Christian Palmberg, Taina Isotalo, Gaelle Fiard, Cecile Verrier, Laura Wiedemann, Emilie Lecornet, Priscilla Leon, Clementine Millet, Charles Ponzio, Guillaume Ploussard, Evanguelos Xylinas, Alexandre Ingels, Pierre Bigot, Vincent Le Corre, François Audenet, Sebastian Berg, Rein-Jueri Palisaar, Axel Heidenreich, Felix Seelemeyer, Susanne Krege, Sami-Ramzi Leyh-Bannurah, Jörn H. Witt, Ayanle Abdirahman, Michael C. Truß, Jennifer Kranz, Karagiannis Andreas, Tzortzis Vassileios, Andreou Andreas, Spyridon Paparidis, Nikolaos Ferakis Niall F. Davis, Kevin G. Keane, Adrian Fuentes, Simone Scuderi, Francesco Barletta, Matteo Manfredi, Francesco Porpiglia, Maria Angela Cerruto, Alessandro Antonelli, Francesco Esperto, Marta Rossanese, Domenico Veneziano, Tommaso Castelli, Roberto La Rocca, Marcello Scarcia, Guglielmo Mantica, Silvia Rebuffo, Giorgio Pomara, Nicola Pavan, Tommaso Silvestri, Giulio Francesco Reale, Andrea Polara, Ugo Giovanni Falagario, Giuseppe Carrieri, Giovanni Ferrari, Maurizio Brausi, Luca Orecchia, Filippo Annino, Gražvydas Kazlauskas, Sotir Stavridis, Nenad Radovic, Marko Vukovic, Margaretha Adriana van der Slot, Harman Maxim Bruins, Inge van Oort, Fred Witjes, Henk van der Poel, Christian Beisland, Gunder Lilleåsenm, Stig Müller, Erik S. Haug, Magne Dimmen, Anna K. Czech, Lukasz Nyk, Jaroslaw Jaskulski, Krzysztof Ratajczyk, Isaac Braga, João Pereira, Rui Lúcio, João Pina, Edgar Miguel Calvo Loureiro Tavares da Silva, Frederico Furriel, Paulo Mota, Miguel Rodrigues, George Daniel Radavoi, Nicolae Crisan, Iulia Andras, Stoica Robert, Ovidiu Bratu, Cristian Surcel, Sergei Kotov, Vigen Malkhasyan, Sergei Petrov, Sergei Reva, Uros Bumbasirevic, Viktor Kováčik, Ivan Perečinský, Ľuboš Rybár, Ján Šulgan, Lukáš Briš, Katarína Jursová, Miroslav Chovan, Tomáš Kička, Milena Taskovska, Rok Kovačič, Andraž Miklavžina, Mario Alvarez-Maestro, Javier Mayor De Castro, Juan Aragón-Chamizo, Raquel Sopeña Sutil, Carmen Garau Perrello, Antoni Vilaseca, Jorge Huguet Perez, Julia Aumatell Ovide, Jacques Planas, Angel Borque-Fernando, Elena Sánchez-Izquierdo, Jose Luis Marenco Jimenez, Guillermo Lendínez-Cano, Ignacio Puche-Sanz, Rodrigo Garcia-Baquero, Mario Domínguez Esteban, Daniel Pérez-Fentes, Patricia Parra Serván, Lotta Renström Koskela, Johan Stranne, Bianca Scholtz, Christian Torbrand, Magnus Wagenius, Henrik Ugge, Joakim Örtegren, Janine Langenauer, Valentin Zumstein, Hans Peter Schmid, Malte Rieken, Karim Saba, Raeto T. Strebel, Ashkan Mortezavi, Cyrill Rentsch, Beat Roth, Daniel Eberli, Oechslin Pascal, Rebecca Auer, Hubert John, George N. Thalmann, Sümer Baltacı, Aydın Mungan, Sinan Sözen, Serhat Cetin, Guven Aslan, Levent Türkeri, Volkan İzol, Çetin Demirdağ, Sami Berk Ozden, Gökhan Toktaş, Şaban Sarikaya, İlker Tinay, Talha Müezzinoğlu, Oguzcan Erbatu, Levent Sagnak, Bülent Akdoğan, Cavit Can, Hayrettin Şahin, Cenk Murat Yazıcı, Serhii Volkov, Olexandr Shulyak, David Douglas, Joshua Hemmant, Omar El-Taji, Imran Ahmad, Sarika Nalagatla, Husay Janebdar, Rajan Veeratterapillay, Bhavan Rai, Samantha Conroy, Marcus Cumberbatch, Sachin Malde, Urology, and Public Health
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SDG 3 - Good Health and Well-being ,Urology ,Androgen deprivation therapy ,Guidelines ,Implementation science ,Prostate cancer - Abstract
Background: Evidence-practice gaps exist in urology. We previously surveyed European Association of Urology (EAU) guidelines for strong recommendations underpinned by high-certainty evidence that impact patient experience for which practice variations were suspected. The recommendation “Do not offer neoadjuvant androgen deprivation therapy (ADT) before surgery for patients with prostate cancer” was prioritised for further investigation. ADT before surgery is neither clinically effective nor cost effective and has serious side effects. The first step in improving implementation problems is to understand their extent. A clear picture of practice regarding ADT before surgery across Europe is not available. Objective: To assess current ADT use before prostate cancer surgery in Europe. Design, setting, and participants: This was an observational cross-sectional study. We retrospectively audited recent ADT practices in a multicentre international setting. We used nonprobability purposive sampling, aiming for breadth in terms of low- versus high-volume, academic, versus community and public versus private centres. Outcome measurements and statistical analysis: Our primary outcome was adherence to the ADT recommendation. Descriptive statistics and a multilevel model were used to investigate differences between countries across different factors (volume, centre type, and funding type). Subgroup analyses were performed for patients with low, intermediate, and high risk, and for those with locally advanced prostate cancer. We also collected reasons for nonadherence. Results and limitations: We included 6598 patients with prostate cancer from 187 hospitals in 31 countries from January 1, 2017 to May 1, 2020. Overall, nonadherence was 2%, (range 0–32%). Most of the variability was found in the high-risk subgroup, for which nonadherence was 4% (range 0–43%). Reasons for nonadherence included attempts to improve oncological outcomes or preoperative tumour parameters; attempts to control the cancer because of long waiting lists; and patient preference (changing one's mind from radiotherapy to surgery after neoadjuvant ADT had commenced or feeling that the side effects were intolerable). Although we purposively sampled for variety within countries (public/private, academic/community, high/low-volume), a selection bias toward centres with awareness of guidelines is possible, so adherence rates may be overestimated. Conclusions: EAU guidelines recommend against ADT use before prostate cancer surgery, yet some guideline-discordant ADT use remains at the cost of patient experience and an additional payer and provider burden. Strategies towards discontinuation of inappropriate preoperative ADT use should be pursued. Patient summary: Androgen deprivation therapy (ADT) is sometimes used in men with prostate cancer who will not benefit from it. ADT causes side effects such as weight gain and emotional changes and increases the risk of cardiovascular disease, diabetes, and osteoporosis. Guidelines strongly recommend that men opting for surgery should not receive ADT, but it is unclear how well the guidance is followed. We asked urologists across Europe how patients in their institutions were treated over the past few years. Most do not use ADT before surgery, but this still happens in some places. More research is needed to help doctors to stop using ADT in patients who will not benefit from it.
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- 2023
37. American Society of Anesthesiologists’ (ASA) Physical Status System and Risk of Major Clavien-Dindo Complications After Robot-Assisted Radical Prostatectomy at Hospital Discharge: Analysis of 1143 Consecutive Prostate Cancer Patients
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Antonio Benito Porcaro, Riccardo Rizzetto, Nelia Amigoni, Alessandro Tafuri, Alberto Bianchi, Sebastian Gallina, Rossella Orlando, Emanuele Serafin, Alessandra Gozzo, Clara Cerrato, Giacomo Di Filippo, Filippo Migliorini, Stefano Zecchini Antoniolli, Giovanni Novella, Vincenzo De Marco, Matteo Brunelli, Maria Angela Cerruto, Enrico Polati, and Alessandro Antonelli
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Postoperative complications ,Prostate cancer ,Oncology ,American Society of Anesthesiologists’ (ASA) ,Robot-assisted radical prostatectomy ,Clavien-Dindo grading complications system ,Physical status system classification ,Radical prostatectomy ,Surgery - Abstract
Objective To test the hypothesis of associations of preoperative physical status system with major postoperative complications at hospital discharge in prostate cancer (PCa) patients treated with robot-assisted radical prostatectomy (RARP). Materials and Methods In a period ranging from January 2013 to October 2020, 1143 patients were evaluated. The physical status was assessed by the American Society of Anesthesiologists’ (ASA) system, which was computed trained anesthesiologists. The Clavien-Dindo system was used to classify postoperative complications, which were coded as major if greater than 1. Results ASA physical status system included class I in 102 patients (8.9%), class II in 934 subjects (81.7%), and class III in 107 cases (9.4%). Clavien-Dindo complications were distributed as follows: grade 1: 141 cases (12.3%), grade 2: 108 patients (9.4%), grade 3a: 5 subjects (0.4%), grade 3b: 9 patients (0.8%), and grade 4a: 3 cases (0.3%). Overall, major complications were detected in 125 cases (10.9%). On multivariate analysis, major Clavien-Dindo complications were predicted by ASA score grade II (adjusted odds ratio, OR = 2.538; 95%CI 1.007–6.397; p = 0.048) and grade III (adjusted OR 3.468; 95%CI 1.215–9.896; p = 0.020) independently by pelvic lymph node dissection (PLND) and/or blood lost. Conclusion In RARP surgery, the risk of major postoperative Clavien-Dindo complications increased as the physical status system deteriorated independently by performing or not a PLND and/or large intraoperative blood lost. The ASA score system was an effective predictor of major Clavien-Dindo complications, which delayed LOHS in RARP surgery. Confirmatory studies are required.
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- 2022
38. African American vs. Caucasian race/ethnicity in adrenocortical carcinoma patients
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Andrea Panunzio, Stefano Tappero, Lukas Hohenhorst, Cristina Cano Garcia, Mattia Piccinelli, Francesco Barletta, Zhe Tian, Alessandro Tafuri, Alberto Briganti, Ottavio De Cobelli, Felix K. H. Chun, Derya Tilki, Carlo Terrone, Fred Saad, Shahrokh F. Shariat, Isabelle Bourdeau, Maria Angela Cerruto, Alessandro Antonelli, and Pierre I. Karakiewicz
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Cancer Research ,Endocrinology ,Oncology ,Endocrinology, Diabetes and Metabolism - Abstract
In some primaries African American race/ethnicity predisposes to higher stage and worse survival. We tested for differences in cancer specific mortality (CSM) and other-cause mortality (OCM) in patients with adrenocortical carcinoma (ACC) according to African American vs. Caucasian race/ethnicity. We hypothesized that African Americans present with higher tumor stage and grade, do not receive the same treatment and benefit of lower survival than Caucasians. Within Surveillance, Epidemiology, and End Results database, we identified 1016 ACC patients: 123 (12.1%) African Americans vs. 893 (87.9%) Caucasians. Propensity score matching (age, sex, marital status, grade, T, N and M stages, treatment type), cumulative incidence plots Poisson-smoothing and competing risk regression (CRR) were used. Compared to Caucasians, African Americans were more frequently unmarried (56.9% vs. 35.5%, p < 0.001). No clinically meaningful or statistically significant differences were observed for age, grade, T, N, and M stages, as well as for treatment type (all p > 0.05). After propensity score matching (1:4), 123 African Americans and 492 Caucasians remained and were included in CRR analysis. In multivariable CRR models, CSM and OCM rates were not different between the two race/ethnicities (hazard ratio: 0.84, p = 0.3). In African Americans five-year CSM rates were 31.2% and 75.3% in respectively European Network for the Study of Adrenal Tumors (ENSAT) stages I-II and III-IV vs. 32.9% and 75.4% in Caucasians. Overall five-year OCM rates were 11.0% vs. 10.1% in respectively African Americans and Caucasians. Unlike other primaries, in ACC African American race/ethnicity is not associated with higher disease stage at initial diagnosis or worse survival.
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- 2023
39. Gender-specific counselling of patients with upper tract urothelial carcinoma and Lynch syndrome
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Clara Cerrato, Savio Domenico Pandolfo, Riccardo Autorino, Andrea Panunzio, Alessandro Tafuri, Antonio Benito Porcaro, Alessandro Veccia, Vincenzo De Marco, Maria Angela Cerruto, Alessandro Antonelli, Ithaar H. Derweesh, and Maria Carmen Mir Maresma
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Urology - Published
- 2023
40. Prognostic impact of palpable prostate tumors on disease progression after robot-assisted radical prostatectomy: a single center experience
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Antonio Benito Porcaro, Sebastian Gallina, Alberto Bianchi, Alessandro Tafuri, Emanuele Serafin, Andrea Panunzio, Giovanni Mazzucato, Rossella Orlando, Francesco Ditonno, Paola Irene Ornaghi, Riccardo Rizzetto, Clara Cerrato, Vincenzo de Marco, Matteo Brunelli, Salvatore Siracusano, Maria Angela Cerruto, and Alessandro Antonelli
- Abstract
Objective: This study aimed to evaluate the impact of palpable prostate tumors on digital rectal exam (DRE) on the disease progression of prostate cancer (PCa) treated with RARP surgery in a tertiary referral center. Materials and methods: Overall 901 patients were evaluated in a period ranging from January 2013 to October 2020. In the surgical specimen, unfavorable pathology included ISUP grade group ≥3, seminal vesicle invasion (SVI), and pelvic lymph node invasion (PLNI). Disease progression was defined as the occurrence of biochemical recurrence and/or local recurrence and/or distant metastases; its association with the primary endpoint was evaluated by Cox’s proportional model. Results: Palpable prostate tumors were detected in 359 (39.8%) patients. The overall median (IQR) follow-up was 40 months (17-59). PCa progressed in 159 cases (17.6%). Nodularity or induration of the prostate at DRE was significantly associated with features of unfavorable pathology, increased risk of PCa progression (hazard ratio, HR=1.902; 95% CI:1.389–2.605; pConclusions: Prostate tumors presenting with an abnormal DRE finding have an independent adverse outcome for disease progression after PCa surgery. They provide also independent prognostic information, as they may be more aggressive than impalpable PCa.
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- 2023
41. Endogenous testosterone density is an independent predictor of pelvic lymph node invasion in high-risk prostate cancer: results in 201 consecutive patients treated with radical prostatectomy and extended pelvic lymph node dissection
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Antonio Benito Porcaro, Alessandro Tafuri, Andrea Panunzio, Giovanni Mazzucato, Clara Cerrato, Sebastian Gallina, Alberto Bianchi, Riccardo Rizzetto, Nelia Amigoni, Emanuele Serafin, Francesco Cianflone, Rossella Orlando, Ilaria Gentile, Filippo Migliorini, Stefano Zecchini Antoniolli, Giacomo Di Filippo, Matteo Brunelli, Vincenzo Pagliarulo, Maria Angela Cerruto, and Alessandro Antonelli
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Male ,Urology ,Percentage of biopsy positive cores density ,High risk prostate cancer ,Risk Assessment ,Prostate specific antigen density ,Pelvis ,Prostate volume ,Tumor load density ,Predictive Value of Tests ,Humans ,Extended pelvic lymph node dissection ,Testosterone ,Endogenous testosterone density ,Aged ,Retrospective Studies ,Prostatectomy ,Prostate cancer ,Endogenous testosterone ,Prostate ,Prostatic Neoplasms ,Pelvic lymph node invasion ,Organ Size ,Middle Aged ,Radical prostatectomy ,Nephrology ,Lymphatic Metastasis ,Lymph Node Excision ,Prostate specific antigen - Abstract
Objective To evaluate the influence of endogenous testosterone density (ETD) on pelvic lymph node invasion (PLNI) in high risk (HR) prostate cancer (PCa) treated with radical prostatectomy (RP) and staged with extended pelvic lymph node dissection (ePLND). Materials and methods ETD was evaluated as the ratio of endogenous testosterone (ET) on prostate volume (PV). HR-PCa was assessed according to the European Association of Urology (EAU) system. The association of ETD and other routinely clinical factors (BPC: percentage of biopsy positive cores; PSA: prostate specific antigen; ISUP: tumor grade system according to the International Society of Urologic Pathology; cT: tumor clinical stage) with the risk of PLNI was assessed by the logistic regression model. Results Overall, 201 out of 805 patients (24.9%) were classified HR and PLNI occurred in 42 subjects (20.9%). On multivariate analysis, PLNI was independently predicted by BPC (OR 1.020; 95% CI 1.006–1.035; p = 0.019), ISUP > 3 (OR 2.621; 95% CI 1.170–5.869; p = 0.019) and ETD (OR 0.932; 95% CI 0.870–0.999; p = 0.045). After categorizing continuous clinical predictors, the risk of PLNI was independently increased by ETD up to the median (OR 2.379; 95% CI 1.134–4.991; p = 0.022), BPC > 50% (OR 3.125; 95% CI 1.520–6.425; p = 0.002) as well as by ISUP > 3 (OR 2.219; 95% CI 1.031–4.776; p = 0.042). Conclusions As ETD measurements decreased, patients were more likely to have PLNI. In HR disease with PLNI, the influence of PCa on ETD should be addressed by higher level studies.
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- 2022
42. Concomitant Radical Cystectomy and Infrarenal Aortic Aneurysm Repair with Cryopreserved Aortic Allograft: A Case Report
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Francesco Cianflone, Alberto Bianchi, Giovanni Novella, Alessandro Tafuri, Maria Angela Cerruto, Andrea Zivi, Gian Franco Veraldi, and Alessandro Antonelli
- Abstract
In localized muscle invasive bladder cancer (MIBC), the gold standard treatment is radical cystectomy (RC) with bilateral pelvic lymph node dissection (PLND), associated with cisplatin-based neoadjuvant chemotherapy, whereas first-line treatment for metastatic patients is cisplatin-based chemotherapy. In men with an abdominal aortic aneurysm (AAA), elective repair is recommended when its diameter is >5.5 cm, while cryopreserved arterial allografts (CAA) offer resistance to infection. A patient with simultaneous metastatic MIBC, associated with left hydronephrosis, and infrarenal AAA of 49 mm diameter was evaluated in an interdisciplinary study. Concomitant surgery was opted for; first, the AAA repair with CAA implantation was practiced, followed by retroperitoneal and common iliac lymphadenectomy. Thereafter, RC and PLND were conducted, and a Wallace-1 ileal conduit and a stoma were constructed. Chest and abdomen contrast-enhanced CT at 2 months showed the onset of two osteolytic lesions on the left ilium. At oncological re-evaluation the patient was deemed cisplatin-fit.
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- 2022
43. Effect of positive surgical margins at radical prostatectomy on cancer-specific mortality in high/very high-risk prostate cancer patients with Gleason Grade Group 4-5
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Andrea Panunzio, Gabriele Sorce, Benedikt Hoeh, Lukas Hohenhorst, Stefano Tappero, Nancy Nimer, Pawel Rajwa, Zhe Tian, Carlo Terrone, Felix K. H. Chun, Alberto Briganti, Fred Saad, Shahrokh F. Shariat, Maria Angela Cerruto, Alessandro Antonelli, and Pierre I. Karakiewicz
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high risk prostate cancer ,Oncology ,Urology ,positive surgical margins ,Gleason Grade Group ,cancer specific mortality - Abstract
The effect of positive surgical margins (PSM) on cancer specific mortality (CSM) in high/very high-risk (HR/VHR) prostate cancer (PCa) with aggressive Gleason Grade Group (GGG) is unknown. We tested PSM effect on CSM in this setting, in addition to testing of radiotherapy (RT) benefit in PSM patients.We relied on Surveillance, Epidemiology, and End Results database (2010-2015), focusing on HR/VHR patients with exclusive GGG 4-5 at radical prostatectomy (RP). Kaplan-Meier plots and multivariable Cox regression models tested the relationship between PSM and CSM. Moreover, the effect of RT on CSM was explored in PSM patients.Of 3383 HR/VHR patients, 15.1% (n = 511) exhibited PSM. Patients with PSM harbored higher rates of GGG 5 (60.1% vs. 50.9%, p 0.001), pathologic tumor stage T3a (69.1% vs. 45.2%, p 0.001) and lymph node involvement (14.1% vs. 9.4%, p 0.001), relative to patients without PSM. PSM rates decreased over time (2010-2015) from 16.0% to 13.6%. Seven-year CSM-free survival rates were 91.6% versus 95.7% in patients with and without PSM, respectively. In multivariable Cox regression models, PSM was an independent predictor of CSM (hazard ratio = 1.6, p = 0.040) even after adjustment for age, prostate specific antigen, pathologic tumor stage and lymph node status. Finally, in PSM patients, RT delivery did not reduce CSM in either univariable or multivariable Cox regression models.In HR/VHR PCa patients with exclusive GGG 4-5, PSM at RP adversely affect survival. Moreover, RT has no protective effect on CSM. In consequence, lowest possible PSM rates are crucial in such patients.
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- 2023
44. Perspectives on the future of urothelial carcinoma therapy: chemotherapy and beyond
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Alberto Bianchi, Markus von Deimling, Maximilian Pallauf, Takafumi Yanagisawa, Tatsushi Kawada, Hadi Mostafaei, Fahad Quhal, Ekaterina Laukhtina, Pawel Rajwa, Muhammad Majdoub, Reza Sari Motlagh, Benjamin Pradere, Pierre I. Karakiewicz, Maria Angela Cerruto, Alessandro Antonelli, and Shahrokh F. Shariat
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Pharmacology ,peptide-drug conjugates ,antibody-drug conjugates ,bladder cancer ,Pharmacology (medical) ,General Medicine ,chemotherapy ,targeted therapy ,upper tract urothelial carcinoma ,epigenetic modifiers ,urothelial carcinoma ,combination therapy ,immunoconjugates - Abstract
Despite recent developments in the landscape of urothelial carcinoma (UC) treatment, platinum combination chemotherapy still remains a milestone. Recently immunotherapeutic agents have gained ever-growing attractivity, particularly in the metastatic setting. Novel chemotherapeutic strategies and agents, such as antibody-drug conjugates (ADCs), and powerful combination regimens have been developed to overcome the resistance of most UC to current therapies.Herein, we review the current standard-of-care chemotherapy, the development of ADCs, the rationale for combining therapy regimens with chemotherapy in current trials, and future directions in UC management.Immunotherapy has prompted a revolution in the treatment paradigm of UC. However, only a few patients experience a long-term response when treated with single-agent immunotherapies. Combination treatments are necessary to bypass resistance mechanisms and broaden the clinical utility of current options. Current evidence supports the intensification of standard-of-care chemotherapy with maintenance immunotherapy. However, the optimal sequence, combination, and duration must be determined to achieve individual longevity with acceptable health-related quality of life. In that regard, ADCs appear as a promising alternative for single and combination strategies in UC, as they specifically target the tumor cells, thereby, theoretically improving treatment efficacy and avoiding extensive off-target toxicities.
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- 2023
45. Learning Curve for Endoscopic Combined Intra-Renal Surgery Using Vacuum-Assisted Device
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Giorgio Mazzon, Francesco Claps, Federico Germinale, Davide Brusa, Simon Choong, Adara Caruso, Marco Pirozzi, Alessandro Antonelli, Maria Angela Cerruto, Antonio Celia, Mazzon, Giorgio, Claps, Francesco, Germinale, Federico, Brusa, Davide, Choong, Simon, Caruso, Adara, Pirozzi, Marco, Antonelli, Alessandro, Cerruto, Maria Angela, and Celia, Antonio
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Renal stone ,Super-mini PCNL ,Urology ,Endoscopic combined intra-renal surgery ,Learning curve ,Training - Abstract
Introduction: The aim of the study was to provide data related to endoscopic combined intra-renal surgery learning curve using minimally invasive techniques with vacuum-assisted devices. Minimal data exist on the learning curve for these techniques. Methods: We conducted a prospective study monitoring the training of a mentored surgeon learning ECIRS with vacuum assistance. We use varied parameters for improvements. After collection of peri-operative data, tendency lines and CUSUM analysis were used to investigate the learning curves. Results: 111 patients have been included. Guy’s Stone Score 3 and 4 stones 51.3% of all cases. The mostly used percutaneous sheath was 16 Fr (87.3%). SFR was 78.4%. 52.3% patients were tubeless, and 38.7% achieved trifecta. High-degree complication rate was 3.6%. Operative time improved after 72 cases. We observed a decrease of complications throughout the case series, with improvement after 17 cases. In terms of trifecta, proficiency was reached after 53 cases. Proficiency seems achievable in a limited number of procedures, but results did not plateau. Higher number of cases might be necessary for excellence. Discussion: A surgeon learning ECIRS with vacuum assistance can obtain proficiency in 17–50 cases. The number of procedures required for excellence remains unclear. Exclusion of more complex cases might positively affect the training, reducing unnecessary complications.
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- 2023
46. Prognostic Impact and Clinical Implications of Unfavorable Upgrading in Low-Risk Prostate Cancer after Robot-Assisted Radical Prostatectomy: Results of a Single Tertiary Referral Center
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Antonio Benito Porcaro, Andrea Panunzio, Alberto Bianchi, Marco Sebben, Sebastian Gallina, Mario De Michele, Rossella Orlando, Emanuele Serafin, Giovanni Mazzucato, Stefano Vidiri, Damiano D’Aietti, Alessandro Princiotta, Francesca Montanaro, Giulia Marafioti Patuzzo, Vincenzo De Marco, Matteo Brunelli, Vincenzo Pagliarulo, Maria Angela Cerruto, Alessandro Tafuri, and Alessandro Antonelli
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ISUP 1 prostate cancer ,adverse pathology ,prostate cancer progression ,tumor upgrading ,Cancer Research ,Oncology - Abstract
Objective: to evaluate predictors and the prognostic impact of favorable vs. unfavorable tumor upgrading among low-risk prostate cancer (LR PCa) patients treated with robot-assisted radical prostatectomy (RARP). Methods: From January 2013 to October 2020, LR PCa patients treated with RARP at our institution were identified. Unfavorable tumor upgrading was defined as the presence of an International Society of Urological Pathology (ISUP) grade group at final pathology > 2. Disease relapse was coded as biochemical recurrence and/or local recurrence and/or presence of distant metastases. Regression analyses tested the association between clinical and pathological features and the risk of unfavorable tumor upgrading and disease relapse. Results: Of the 237 total LR PCa patients, 60 (25.3%) harbored unfavorable tumor upgrading. Disease relapse occurred in 20 (8.4%) patients. Unfavorable upgrading represented an independent predictor of disease relapse, even after adjustment for other clinical and pathological variables. Conversely, favorable tumor upgrading did not show any statistically significant association with PCa relapse. Unfavorable tumor upgrading was associated with tumors being larger (OR: 1.03; p = 0.031), tumors extending beyond the gland (OR: 8.54, p < 0.001), age (OR: 1.07, p = 0.009), and PSA density (PSAD) ≥ 0.15 ng/mL/cc (OR: 1.07, p = 0.009). Conclusions: LR PCa patients with unfavorable upgrading at final pathology were more likely to be older, to have PSAD ≥ 0.15 ng/mL/cc, and to experience disease relapse. Unfavorable tumor upgrading is an issue to consider when counseling these patients to avoid delayed treatments, which may impair cancer-specific survival.
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- 2022
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47. MRI-Derived Apparent Diffusion Coefficient of Peri-Prostatic Adipose Tissue Is a Potential Determinant of Prostate Cancer Aggressiveness in Preoperative Setting: A Preliminary Report
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Alessandro Tafuri, Andrea Panunzio, Federico Greco, Antonella Maglietta, Francesco De Carlo, Federica Di Cosmo, Elia Luperto, Mino Rizzo, Arturo Cavaliere, Rita De Mitri, Federico Zacheo, Marco Baviello, Alessandra Cimino, Marco Pisino, Luca Giordano, Caterina Accettura, Antonio Benito Porcaro, Alessandro Antonelli, Maria Angela Cerruto, Elisa Ciurlia, Silvana Leo, Luigi Giuseppe Quarta, and Vincenzo Pagliarulo
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Male ,Health, Toxicology and Mutagenesis ,prostate biopsy, prostate cancer, MRI, ADC, periprostatic adipose tissue ,Public Health, Environmental and Occupational Health ,Prostate ,Prostatic Neoplasms ,prostate cancer ,Magnetic Resonance Imaging ,ADC ,Adipose Tissue ,Humans ,prostate biopsy ,MRI ,periprostatic adipose tissue ,Retrospective Studies - Abstract
Background: The aim of this study was to test the association between periprostatic adipose tissue (PPAT)—apparent diffusion coefficient (ADC) value recorded at multiparametric magnetic resonance imaging (mpMRI) and determinants of prostate cancer (PCa) aggressiveness in the preoperative setting. Methods: Data from 219 consecutive patients undergoing prostate biopsy (PBx) for suspicion of PCa, between January 2020 and June 2022, at our institution were retrospectively evaluated. Only patients who had mpMRI performed before PBx were included. The distribution of demographics and clinical features among PPAT-ADC values up to vs. above the median was studied using both parametric and non-parametric tests, according to variables. Linear and logistic regression models tested the association between PPAT-ADC values and determinants of PCa aggressiveness and the presence of intermediate-high risk PCa, respectively. Results: Of 132 included patients, 76 (58%) had PCa. Median PPAT-ADC was 876 (interquartile range: 654 − 1112) × 10−6 mm2/s. Patients with PPAT-ADC up to the median had a higher rate of PIRADS (Prostate Imaging—Reporting and Data System) 5 lesions (41% vs. 23%, p = 0.032), a higher percentage of PBx positive cores (25% vs. 6%, p = 0.049) and more frequently harbored ISUP (International Society of Urological Pathology) > 1 PCa (50% vs. 28%, p = 0.048). At univariable linear regression analyses, prostate-specific antigen (PSA), PSA density, PIRADS 5, and percentage of PBx positive cores were associated with lower PPAT-ADC values. PPAT-ADC up to the median was an independent predictor for intermediate-high risk PCa (odds ratio: 3.24, 95%CI: 1.17–9.46, p = 0.026) after adjustment for age and body mass index. Conclusions: Lower PPAT-ADC values may be associated with higher biopsy ISUP grade group PCa and a higher percentage of PBx-positive cores. Higher-level studies are needed to confirm these preliminary results.
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- 2022
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48. Endogenous testosterone density as ratio of endogenous testosterone levels on prostate volume predicts tumor upgrading in low-risk prostate cancer
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Alessandro Antonelli, Rossella Orlando, Stefano Zecchini Antoniolli, Sebastian Gallina, Emanuele Serafin, Salvatore Siracusano, Vincenzo Lacola, Alessandro Tafuri, Alberto Bianchi, Antonio Benito Porcaro, Matteo Brunelli, Clara Cerrato, Riccardo Rizzetto, Alessandra Gozzo, Vincenzo De Marco, Maria Angela Cerruto, Nelia Amigoni, and Filippo Migliorini
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Nephrology ,Male ,medicine.medical_specialty ,Multivariate analysis ,Tumor upgrading ,Urology ,Endogeny ,BPC density (BPCD) ,Endogenous testosterone (ET) ,ET density (ETD) ,Low-risk prostate cancer ,Percentage of biopsy positive cores (BPC) ,Prostate cancer ,Prostate-specific antigen (PSA) ,PSA density (PSAD) ,Radical prostatectomy ,Prostate ,Internal medicine ,Biopsy ,medicine ,Humans ,Testosterone ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,Urology - Original Paper ,business.industry ,Prostatic Neoplasms ,Odds ratio ,Middle Aged ,Prostate-Specific Antigen ,medicine.disease ,Tumor Burden ,medicine.anatomical_structure ,Biopsy, Large-Core Needle ,Neoplasm Grading ,business - Abstract
Objectives To evaluate preoperative endogenous testosterone (ET) density (ETD), defined as the ratio of ET on prostate volume, and tumor upgrading risk in low-risk prostate cancer (PCa). Materials and methods From November 2014 to December 2019, 172 low-risk patients had ET (nmol/L) measured. ETD, prostate-specific antigen density (PSAD) and the ratio of percentage of biopsy positive cores (BPC) to prostate volume (PV), defined as BPC density (BPCD), were evaluated. Associations with tumor upgrading in the surgical specimen were assessed by statistical methods. Results Overall, 121 patients (70.3%) had tumor upgrading, which was predicted by BPCD (odds ratio, OR = 4.640; 95% CI 1.903–11.316; p = 0.001; overall accuracy: 70.3%). On multivariate analysis, tumor upgrading and clinical density factors related to each other for BPCD being predicted by ETD (regression coefficient, b = 0.032; 95% CI 0.021–0.043; p b = 1.962; 95% CI 1.067–2.586; p b = 0.259; 95% CI 0.112–0.406; p = 0.001). According to the model, as BPCD increased, ETD and PSAD increased, but the increase was higher for upgraded cases who showed either higher tumor load but significantly lower mean levels of either ET or PSA. Conclusions As ETD increased, higher tumor loads were assessed; however, in upgraded patients, lower ET was also detected. ETD might stratify low-risk disease for tumor upgrading features.
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- 2021
49. Endogenous testosterone density predicts unfavorable disease at final pathology in intermediate risk prostate cancer
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Matteo Brunelli, Clara Cerrato, Nelia Amigoni, Emanuele Serafin, Alberto Bianchi, Riccardo Rizzetto, Antonio Benito Porcaro, Alessandro Antonelli, Alessandra Gozzo, Sebastian Gallina, Andrea Panunzio, Aliasger Shakir, Giovanni Novella, Alessandro Tafuri, Francesco Cianflone, Maria Angela Cerruto, Giacomo Di Filippo, and Filippo Migliorini
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Male ,Pathology ,medicine.medical_specialty ,Tumor upgrading ,Urology ,medicine.medical_treatment ,Logistic regression ,Prostate cancer ,Risk Factors ,Tumor upstaging ,Prostate ,Biopsy ,Humans ,Medicine ,Testosterone ,Endogenous testosterone density ,Aged ,Urology - Original Paper ,medicine.diagnostic_test ,business.industry ,Prostatectomy ,Endogenous testosterone ,Prostatic Neoplasms ,Intermediate risk prostate cancer ,Prostate-specific antigen ,Radical prostatectomy ,Unfavorable disease ,Cancer ,Middle Aged ,Prognosis ,medicine.disease ,Tumor Burden ,medicine.anatomical_structure ,Nephrology ,Neoplasm Grading ,business - Abstract
Objective To test the hypothesis that endogenous testosterone (ET) density could be associated with tumor load (TL) in patients with intermediate risk (IR) prostate cancer (PCa). Materials and methods Endogenous testosterone density (ETD, ratio between ET and prostate volume [PV]), biopsy positive cores density (BPCD, the ratio between the number of positive cores and PV) and prostate-specific antigen density (PSAD, ratio between total PSA and PV) were retrospectively evaluated on a prospectively collected data on 430 patients with IR PCa submitted to radical prostatectomy (RP). Tumor load (TL) was measured as the percentage of prostatic volume occupied by cancer at final pathology. Unfavorable disease (UD) was defined as tumor upgrading (ISUP grading group 4, 5) and/or upstaging (pT3a or 3b) in prostate specimens. Associations were assessed by the logistic regression and linear regression models. Results Overall, UD, which was detected in 122 out of 430 IR patients (28.4%), was predicted by BPCD (odd ratio, OR = 1.356; 95% CI 1.048–1.754; p = 0.020) with a sensitivity 98.4% and overall accuracy 71.9%. On multivariate analysis, BPCD was independently predicted by PSAD (regression coefficient, b = 1.549; 95% CI 0.936–2.162; p b = 0.032; 95% CI 0.023–0.040; p b = 0.009; 95% CI 0.005–0.014; p 1.0%/mL had significantly lower ET levels. Conclusions As ETD increased, BPCD and TL increased, accordingly; furthermore, patients with lower ET levels were more likely to have occult UD. The influence of tumor load, and unfavorable disease on ET and ETD needs to be addressed by further studies.
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- 2021
50. Contemporary conditional cancer-specific survival rates in surgically treated adrenocortical carcinoma patients: A stage-specific analysis
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Andrea Panunzio, Francesco Barletta, Stefano Tappero, Cristina Cano Garcia, Mattia Piccinelli, Reha‐Baris Incesu, Kyle W. Law, Zhe Tian, Alessandro Tafuri, Derya Tilki, Ottavio De Cobelli, Felix K. H. Chun, Carlo Terrone, Alberto Briganti, Fred Saad, Shahrokh F. Shariat, Isabelle Bourdeau, Maria A. Cerruto, Alessandro Antonelli, and Pierre I. Karakiewicz
- Subjects
conditional survival ,Oncology ,adrenalectomy ,Surgery ,General Medicine ,ACC - Abstract
We examined the effect of disease-free interval (DFI) duration on cancer-specific mortality (CSM)-free survival, otherwise known as the effect of conditional survival, in surgically treated adrenocortical carcinoma (ACC) patients.Within the Surveillance, Epidemiology, and End Results database (2004-2018), 867 ACC patients treated with adrenalectomy were identified. Conditional survival estimates at 5-years were assessed based on DFI duration and according to stage at presentation. Separate Cox regression models were fitted at baseline and according to DFI.Overall, 406 (47%), 285 (33%), and 176 (20%) patients were stage I-II, III and IV, respectively. In conditional survival analysis, providing a DFI of 24 months, 5-year CSM-free survival at initial diagnosis increased from 66% to 80% in stage I-II, from 35% to 66% in stage III, and from 14% to 36% in stage IV. In multivariable Cox regression models, stage III (hazard ratio [HR]: 2.38; p 0.001) and IV (HR: 4.67; p 0.001) independently predicted higher CSM, relative to stage I-II. The magnitude of this effect decreased over time, providing increasing DFI duration.In surgically treated ACC, survival probabilities increase with longer DFI duration. This improvement is more pronounced in stage III, followed by stages IV and I-II patients, in that order. Survival estimates accounting for DFI may prove valuable in patients counseling.
- Published
- 2022
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